High shear stress on the background of clinical restenosis at the site of step-down phenomenon after drug eluting stent implantation

Abstract

Please cite this article as: C. Jenei, et al., High shear stress on the background of clinical restenosis at the site of step-down phenomenon after drug eluting stent implantation, Cor et Vasa 58 (2016) e518-e521 as published in the online version of Cor et Vasa available at SOUHRNU nemocného s restenózou zjištěnou šest měsíců po implantaci lékového stentu (drug-eluting stent, DES) byla ve snaze zhodnotit vliv zmenšování průměru stentu směrem k jeho distálnímu konci (step-down) na smykové napětí ve stěně tepny (wall shear stress, WSS) provedena retrospektivní remodelace 3D koronarografi ckou rekonstrukcí a průběhu intrakoronárního tlaku během srdečního cyklu. Kinetika WSS se vypočítávala v průběhu celého cyklu podél rekonstruované tepny metodou analýzy dynamiky tekutin. Na rozdíl od starších zpráv byla největší amplituda a průměrná hodnota WSS tepny zjištěna v místě zmenšení průměru (step-down), kde později došlo ke vzniku restenózy. ABSTRACT A retrospective modeling was performed in a case with restenosis after 6 months of a DES implantation to investigate the effect of the step-down at the distal edge of the stent on the wall shear stress (WSS) using 3D coronary angiography reconstruction and the intracoronary pressure traces during a cardiac cycle. The kinetics of the WSS was calculated through the cardiac cycle along the reconstructed vessel by fl uid dynamic analysis. Contrary to the previous reports the greatest amplitude and average of the arterial WSS was detected where the restenosis developed later at the site of the step-down.

Wall shear stress in the development of in-stent restenosis revisited. A critical review of clinical data on shear stress after intracoronary stent implantation

“…These authors concluded that the mechanism of prevention of restenosis in the side branch in the case of provisional stenting (without side-branch stent) works by increasing the WSS, while in the main branch, the mechanism of prevention of restenosis is secondary to drug elution. A case report has recently been published of restenosis in a straight vessel segment with a very high shear stress near the site of step-down phenomenon [28], raising the possibility of extremely high WSS being associated with restenosis at the distal edge of the DES (Table 2).…”

The Role of Elevated Wall Shear Stress in Progression of Pulmonary Vein Stenosis: Evidence from Two Case Studies

“…Binns et al implanted PTFE grafts of different sizes in dog arteries and showed that the smallest grafts, which were exposed to a pathologically high WSS of 41 dyn/cm 2 , developed pseudointimal hyperplasia and loss of patency by 15 weeks [ 12 ]. Abnormally high WSS levels have also been associated with sites of artery stenosis caused by neointimal hyperplasia immediately distal to coronary stents [ 13 ]. Similar effects have been observed in veins.…”